In November 2022, the Centers for Disease Control and Prevention (CDC) released new voluntary guidelines on prescribing opioids, replacing the stricter guidance issued in 2016. These guidelines are aimed at giving doctors greater flexibility while encouraging them to work collaboratively with patients in finding the best approaches to pain management. The 2016 guidance led to a regulatory crackdown on opioids, which is why insurers and claims administrators in the workers’ compensation industry are keeping an eye on how these new guidelines will impact the industry.
Since the 1990s, the use of opioids has surged to become a major public health crisis in the United States. While opioids have been a preferred medication for treating pain resulting from workplace injuries, their use has led to addiction, overdose, and other related problems. The 2016 CDC guidance was issued as a response to this crisis and became the basis for many states to impose mandatory restrictions. However, the new guidelines recognize the need for balance in opioid prescribing practices while ensuring that patients’ needs are met.
According to Phil Walls, the chief clinical officer for myMatrixx, an increasing number of new workplace injury claims are no longer receiving opioid prescriptions. This shift is because many medical professionals have discovered that there are safer and more effective pain management options that do not have the same side effects as opioids. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are one such alternative that is safer for healthy adults. NSAIDs have their own risks but when compared to opioids, they are much safer.
Despite this shift, workers’ comp experts are concerned about the potential for an uptick in opioid prescriptions, especially for cases involving chronic pain. Insurers and claims administrators are monitoring prescription data for signs of misuse, such as unusual prescription patterns or deviations from standards of care. Potential indicators of misuse include the frequency and timing of prescription fills, which could indicate overuse of pills or stockpiling. Monitoring for potentially dangerous combinations of drugs, such as opioids prescribed alongside benzodiazepine or gabapentin, is also essential because these combinations increase the risk of overdose.
Rising opioid dosages could also be a source of concern as they may indicate potential misuse. Workers’ comp experts caution that while the new guidelines provide doctors with greater leeway in prescribing opioids, they must also remain vigilant in ensuring that patients receive the best possible care while avoiding potential addiction and other related problems.
“We as clinical professionals do not want to micromanage every single thing in a claim,” said Jennifer Cogbill, senior vice president for GBCARE client services at Gallagher Bassett. “We want to intervene, though, when it becomes clear that there’s a problem.”
The opioid crisis has led to the implementation of strict regulations to combat its adverse effects. As the CDC relaxes its opioid guidance, workers’ comp experts must remain vigilant and alert for any potential red flags. While the new guidelines aim to strike a balance between pain management and patient safety, it is up to the industry to ensure that these guidelines are implemented in a way that prioritizes the wellbeing of workers. Insurers and claims administrators must be proactive in monitoring prescription data, identifying signs of misuse, and intervening where necessary to prevent addiction and other related problems. By doing so, they can help ensure that workers receive the best possible care while avoiding the potentially harmful effects of opioid addiction.
